Friday 22nd of November 2024
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Gross Conflict of Interest for The Insurers

Insurers should cough up: Law Council.

Employer's are duty bound and required by law to have Workers Compensation Insurance to protect their workers and themselves against medical expenses and loss of income in the event of an accident occurring in the course of the employee executing theor duties. This should entitle the employee to have access to the medical treatment deemed neccessary by the treating doctor or specialist. It should also cover the employee against loss of income until the treating Doctor or specialist deems the employee fir to return to work. The employer is exercising Duty of Care to the employee.

This Duty of Care is transferred to an Insurer when a workplace accident does occur. at the same time the Insurer has a Duty of Care to its shareholders and the prime purpose of maximising profit. There exists then an obvious conflict of interest.

So where does this leave the injured worker?

Under current legislation in NSW, the Insurers have been given total control and the power to deny the injured worker medical treatment reccommended and requested by the treating Doctor or Specialist by stating that they do not think it is neccessary. The insurer also has the power to further reduce the injured workers income to the "statutory award", which is far far below the workers basic wage. Of course the worker remains declared totally unfit for any duties whatsoever by the treating Doctor or Specialist.

Workers Compo

Hey Heather,

Not sure what point you are making here. This is not new. It has been the case for many years. Workers Compo looks all warm and fuzzy in the legislation but in practice most claimants are treated as fakes and frauds. Of course there are some of those, too many in fact. But the same old deal applies. Because the few abuse a system all suffer the slurs, bullying and stigma that go with it.

I consider Workers Compo these days to be an umbilical cord which is tied around your neck. You need the sustenance but the contact strangles and sickens you.

The one salient point Heather is that if you have good medical support and advice then you can stand up to the lawyers and insurance bullies who think it's a game. And it is to them. They see that bullying 1000 people results in 500 cases disappearing so they bully everybody. They deny claims, delay entitlements, hire those who sell their medical quals for a few grand. But they don't want to go to court if you have good backup, medical. That's the only saving grace in the dreadful system.

Injured Worker Has Become Functional

Hi Pegasus,

Thanks for responding. I am not sure that I knew what point I was trying to make either,  just knew it was time to  start the ball rolling  and  see if there is anyone else out there, that visits this site, that has in any way had to suffer or knows of someone suffering the injustices and indignities that result with having been injured in the workplace.

January 2002 the Carr government implemented legislation and have continued to make further ammendments which give power to the insurer over the injured worker. The injured worker can have the best medical advice available but to act upon that advice the injured worker must seek the approval of the insurer. This approval must be given prior to any treatment being commenced. The insurer has the power to deny the injured worker  treatment, reccommended by the treating medical proffessionals, by claiming that it is not reasonable or neccessary.  Reasonable and necessary  are the terms used  in the Workers Compensation Act.  A qualified treating  Doctor or Specialist request  should be all that is required to be "neccessary".  Any effort to restore the injured workers health is surely "reasonable".

Insurance is a business. Business has a sole purpose, it is to make a profit.

Therefore the  injured worker is functional to the insurer. The insurer makes money from the   injured worker. For the insurer to have the right of veto over reccommended treatment for the injured worker when, their business is to make money, has to be a conflict of interest.

Injured worker

Hi, I have been in the workers Comp system for over 3 yrs now. I needed to be admitted to hospital due to a severe spinal injury. The insurer refused! Being doctors and all I know that their decision was medically based  ;)

My specialist and GP overruled them and I subsequently spent 9 weeks in hospital.

It took me near on 3 yrs to have them accept payment for my hospitalisation.

They stalled me all the way and still are refusing to negotiate a fair payout.

Their starve -out tactics are well known worldwide.

Btw my specialist and the insurers have given me a 20% permanent disability.

After lawyers fees and paying all the medical expenses out i would be left with around $7,000, based on their last "offer". Unable to ever return to my trade, and tell me who is going to employ someone with such a serious injury? Ask any employer ( I have), no one will; I`m too high a risk.

Oh and the previous doctors and specialists employed by the Insurers told me it would get better to there`s nothing that can be done to help you, get on with your life, dont fight.

I wont talk about the stress and depression that is enjoyed by upwards of 90% of all long term WC sufferers.

Oh and can someone please tell me why an injured worker needs a lawyer? Don`t criminals need lawyers? Ah yes, and that is where I will end this little diatribe.

On a positive note I am looking at starting a group to help others who are in this system. Anybody who reads this and has any info or experiences in the WC system is welcome to contact me.